Wellington ED cuts back “just-in-case” IV use after research review

A nurse-led project has led to a major cut back in intravenous use in Wellington Regional Hospital’s emergency department after research showing half of patients receive IV treatment unnecessarily.

January 29, 2018

A nurse-led project has led to a major cut back in intravenous use in Wellington Regional Hospital’s emergency department after research showing half of patients receive IV treatment unnecessarily.

Lynne Gledstone-Brown

There has been a 30 per cent reduction in IV insertions performed at Wellington’s ED after the Practice Responsible IV Cannulation Today (PRICT) was introduced by ED nurse Lynne Gledstone-Brown.

The project followed a research review led by Gledstone-Brown, recently published in Emergency Medicine Australasia, which indicated about half of ED patients who receive IV cannulation insertions don’t need them.

“That’s half of the IV cannulation insertions performed a day that are made on a ‘just in case’ basis and are effectively unused,” said Gledstone-Brown. “This project was focused on doing what’s right for patients, based on what they actually need.”

The Wellington PRICT project focused on encouraging doctors and nurses to assess whether there was a clear need to insert an IV into a patient to administer medication or fluid.

Within four months the project has led to a 30 percent reduction in IV use in ED which meant patients were avoiding unnecessary pain but it was also saving the Capital & Coast District Health Board around $72,000 a year in needles and cannulas.

Gledstone-Brown said the project had led to a “massive cultural shift” across the hospital and the departments. “ED doctors and nurses are working closely together to make decisions around whether the administration of IV fluids or medication is necessary.”

She is now working with 10 other DHBs to garner interest in implementing the new guidelines in their EDs.

The research review she led looked at 21 articles published in the past 24 years that addressed redundant peripheral intravenous cannula (PIVC) use.

The review team concluded that while inserting an PIVC was often an essential ED precursor to lifesaving treatment it was not harmless and many patients received “just-in-case” PIVCs that remain unused or idle.

The review team found common themes in the research literature included that unneeded PIVC were related to preventable intravascular complications, financial burden, loss of time and a culture of over-investigating.

“This practice (redundant or idle PIVCs) is associated with compromised patient safety, squandered finances and misdirected practitioner time,” said the review report. “Cultures of convenience and shortfalls in PIVC-related education facilitate the prevalence of idle PIVCs.”